2012-08-14T14:55:06-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-10-01 410785161 MILLE LACS HEALTH SYSTEM MILL 3205322580 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 WILLIAM NELSON 3205322580 2012-08-09 1 6123764500 2010 2016-02-24 21:20:13Z WILLIAM NELSON 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 36747081 0 X WWW.MLHEALTH.ORG X 1953 MN TO PROVIDE QUALITY HEALTH SERVICES TO RESIDENTS OF ONAMIA, MN AND THE SURROUNDING AREA. 10 7 552 40 0 0 166453 246527 34713877 35951800 59254 74470 430789 474284 35370373 36747081 60000 60000 0 0 19419413 20388123 0 0 2280 14224526 14267318 33703939 34715441 1666434 2031640 28768186 31484361 15823667 16537096 12944519 14947265 X TO ASSIST THOSE RESIDING IN AND VISITING THE MILLE LACS AREA IN ACHIEVING AND MANTAINING OPTIMAL HEALTH. 0 0 29936799 60000 35951800 MILLE LACS HEALTH SYSTEM (MLHS) IS A RURAL HEALTH SYSTEM LOCATED IN ONAMIA, MN, 80 MILES NORTH OF THE TWIN CITIES ON THE SOUTH SHORE OF LAKE MILLE LACS. OUR SYSTEM INCLUDES A 25-BED ACUTE CARE HOSPITAL, A 57-BED LONG-TERM CARE FACILITY, A 10-BED SENIOR CARE FACILITY, HOME CARE, HOSPICE, A BLS AND PART-TIME ALS AMBULANCE SERVICE, AS WELL AS AN ATTACHED MEDICAL CLINIC. MLHS ALSO OPERATES CLINICS IN THE TOWNS OF ISLE, HILLMAN, GARRISON AND MILACA. OUR MEDICAL STAFF ALSO PROVIDES COVERAGE TO THE NE-LA-SHING CLINIC ON THE NEARBY MILLE LACS RESERVATION. THE HEALTH SYSTEM IS ORGANIZED AS A 501(C)(3) NONPROFIT CORPORATION. DUE TO THE LACK OF AVAILABLE HEALTHCARE OPTIONS IN THIS CENTRAL MINNESOTA REGION, THE FEDERAL GOVERNMENT HAS DESIGNATED THIS COMMUNITY AS A MEDICALLY UNDERSERVED AREA IN TERMS OF PRIMARY CARE CLINICS. THE REMOTENESS OF HEALLHCARE SERVICES TO THE MILLE LACS COMMUNITIES IN THE 1950'S PROMPTED AN AREA-WIDE COMMUNITY EFFORT TO BUILD A HOSPITAL. THE HOSPITAL WAS COMPLETED IN 1956 AND, FIVE YEARS LATER A NURSING HOME WAS BUILT ADJACENT TO IT. OVER THE YEARS, THE FACILITIES HAVE BEEN EXPANDED AND MODERNIZED AND RENAMED SEVERAL TIMES. IN 1995, AN AMBITIOUS BUILDING PROJECT AND INTEGRATION EFFORT, WHICH INCLUDED A NEW HOSPITAL EMERGENCY ROOM, REHABILITATION CENTER, AND CLINIC SPACE WERE COMPLETED. THIS BUILDING PROJECT WAS MADE POSSIBLE THROUGH NEARLY A HALF MILLION DOLLARS WHICH WERE RAISED LOCALLY. IN 2001, A MULTI-MILLION DOLLAR EXPANSION AND RENOVATION PROJECT WAS STARTED TO FURTHER UPGRADE THE HOSPITAL AND LONG-TERM CARE SERVICES AND POSITION US TO MEET THE GROWING HEALTHCARE NEEDS OF THE AREA. IN 2010, AN EXPANSION PROJECT INCLUDED NEW SPACE IN THE BASEMENTE OF LAKE SONG ASSISTED LIVING; EXPANSION AND REMODEL OF THE ONAMIA CLINIC; NEW PHARMACY DEPARTMENT; AND A NEW OUT-PATIENT DEPARTMENT.MILLE LACS HEALTH SYSTEM SERVES A PERMANENT POPULATION OF BETWEEN 12,000 AND 15,000, INCLUDING RESIDENTS OF THE MILLE LACS RESERVATION. BECAUSE OF THE RECREATIONAL FEATURES OF THE MILLE LACS AREA, MLHS ALSO SERVES A NUMBER OF SEASONAL RESIDENTS. IT IS ESTIMATED THAT DURING THE BUSY SUMMER AND HOLIDAY WEEKENDS THERE ARE UP TO AN ADDITIONAL 25,000 PEOPLE IN THE AREA. THIS NUMBER IS BASED ON STATISTICS FROM LOCAL RESORTS, MOTELS, AND CAMPGROUNDS. THE CLOSEST ACUTE CARE FACILITY IS 38 MILES AWAY IN PRINCETON. THE CLOSEST TERTIARY CARE FACILITY IS 55 MILES AWAY IN ST. CLOUD. THE CLOSEST SECONDARY LEVEL IS 50 MILES AWAY IN BRAINERD. MLHS IS THE ONLY PROVIDER OF ACUTE CARE WITHIN OUR PRIMARY SERVICE AREA OF ONAMIA, HILLMAN, ISLE, GARRISON AND WAHKON, WHICH INCLUDES THE MILLE LACS RESERVATION.MILLE LACS HEALTH SYSTEM ALSO SERVES PATIENTS OUTSIDE THE PRIMARY SERVICE AREA. THE SECONDARY SERVICE AREA INCLUDES MORA, BOCK, MILACA, AND OGILVIE. 29936799 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 75 0 552 1 0 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JOHN UNZEN CFO 3205322580 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 X MARK TADYCH 8.00 X X 4800 0 0 KEVIN ANDERSON 2.00 X X 780 0 0 JUDY WAYTASHEK 2.00 X X 660 0 0 DIANE GIBAS 2.00 X X 660 0 0 STEVE LONG 2.00 X 450 0 0 BECKY HOULE 2.00 X 750 0 0 FR KERMIT HOLL OSC 2.00 X 570 0 0 GAIL KULICK-JACKSON 2.00 X 210 0 0 ARDEN VIRNIG 40.00 X 177520 0 7630 MAGGIE LARSON 40.00 X 160266 0 24092 WILLIAM NELSON 40.00 X 248356 0 15203 JOHN UNZEN 40.00 X 141485 0 5967 TOM BRACKEN 40.00 X 198831 0 25470 RODNEY HAYES 40.00 X 169353 0 24402 FERN GERSHONE 40.00 X 129053 0 5482 KIM KUCERA 40.00 X 141174 0 21776 SHARON GOSSETT 40.00 X 512723 0 25591 CATHY DONOVAN 40.00 X 168966 0 20035 PETER LINDBLOOM 40.00 X 153215 0 23923 MARK MARSHALL 40.00 X 137459 0 12884 ROGER BOETTCHER 40.00 X 191741 0 26216 2409969 0 233189 6 0 1 0 ANDERSON BUILDERS INC 4220 PARK GLEN ROAD ST LOUIS PARK MN 55416 BUILDER/REMODLER 1481245 CMDI 150 10TH STREET NW MILACA MN 56353 MRI/RADIOLGY 1269301 JUSTIN TOWNE CENTRAL MN ANESTHESIA 9527 330TH ONAMIA MN 56359 CRNA 492298 BEHAVIORAL HEALTH CONCEPTS INC 305 CALLE VILLARIO SAN CLEMENTE CA 92672 COUNSELING SENIOR CARE 404661 HEALTHCARE MANAGEMENT SYSTEMS INC 2739 MOMENTUM PLACE CHICAGO IL 60689 HEALTHCARE SOFTWARE/MAINTENANCE SERVICES 376759 14 84521 104783 57223 246527 PATIENT REVENUE 621110 34718656 34718656 JOINT VENTURE INCOME 900099 618538 618538 ASSISTED LIVING 623000 483551 483551 CLINIC REVENUE 900099 99496 99496 THERAPY REVENUE 900099 31559 31559 35951800 72593 72593 39916 39916 39916 39916 1877 1877 1877 1877 87367 87367 87367 MEALS REVENUE 900099 298118 298118 MISCELLANEOUS 900099 43893 43893 DISCOUNTS & REBATES 900099 4990 4990 347001 36747081 35951800 0 548754 60000 60000 755368 344599 410769 13399640 12292852 1104508 2280 373744 345304 28440 4750955 4506422 244533 1108416 984840 123576 36431 36431 194217 194217 3902400 3277600 624800 165181 1881 163300 948579 570063 378516 529622 501125 28497 202903 152019 50884 8344 8344 676886 615232 61654 2149191 1584815 564376 309521 238409 71112 MEDICAL SUPPLIES 2039857 2039857 BAD DEBT EXPENSE 1525036 1525036 TAXES 631346 247193 384153 FOOD 387997 387997 REPAIRS & MAINTENANCE 185274 172252 13022 374533 89303 285230 34715441 29936799 4776362 2280 7164814 21098 238000 8974753 6138589 6031865 204968 185165 296657 346175 642706 711374 34903242 21242684 12693668 13660558 1293269 1463926 95515 89447 28768186 31484361 2522912 2122213 10446453 10075033 2399302 3703850 455000 636000 15823667 16537096 X 12886775 14918416 57744 28849 12944519 14947265 28768186 31484361 X 2031640 -28895 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 365798 365798 21937792 12497041 9440751 924384 615628 308756 10827077 8130015 2697062 848191 848191 13660558 DUE TO THIRD PARTY PAYORS 636000 636000 36747081 34715441 2031640 -28895 -28895 2002745 36426084 0 36426084 320997 320997 36747081 34715440 0 34715440 0 34715440 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: INCOME TAXES THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE TAX YEARS 2008 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS -28,895. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNRESTRICTED CONTRIBUTIONS 144,202. INTEREST INCOME 72,012. GRANT INCOME 104,783. 1 1 X 1 X 1 X 1 1 1 0 1 1 774187 0 774187 0.02330 5508062 3923200 1584862 0.04780 6282249 3923200 2359049 0.07110 35255 35255 0.00110 165703 15919 149784 0.00450 13639 13639 0.00040 214597 15919 198678 0.00600 6496846 3939119 2557727 0.07710 0 981241 335192 4658325 10922091 -6263766 X 1 0 1 1 MILLE LACS HEALTH SYSTEM HOSPITAL

200 NORTH ELM STREET ONAMIA MN 563590800

X X X X NA 1 7 MLHS - LONG TERM CARE

200 NORTH ELM ST ONAMIA MN 56359

SKILLED NURSING FACILITY MLHS FAMILY CLINIC - GARRISON

27378 STATE HWY 18 GARRISON MN 56450

MEDICAL CLINIC MLHS FAMILY CLINIC - ISLE

375 WEST ISLE ST ISLE MN 56342

MEDICAL CLINIC MLHS FAMILY CLINIC - ONAMIA

200 NORTH ELM ST ONAMIA MN 56359

MEDICAL CLINIC MLHS FAMILY CLINIC - HILLMAN

26362 370TH AVE HILLMAN MN 56338

MEDICAL CLINIC MLHS HOME CARE AND HOSPICE

200 NORTH ELM ST ONAMIA MN 56359

MEDICAL CLINIC MLHS CHIROPRACTIC AND PHYSICAL THERAPY

1010 5TH STREET SE MILACA MN 56353

CHIROPRACTIC PART I, LINE 3C: THE FEDERAL POVERTY INCOME GUIDELINES PROVIDE THE INITIAL FRAMEWORK TO DETERMINE THE INDIVIDUAL'S ABILITY TO PAY. INDIVIDUALS WITH INCOME AND ASSETS EQUAL TO OR LESS THAN THE FEDERAL POVERTY INCOME GUIDELINES, WITH NO OTHER AVAILABLE ASSETS MUST BE EVALUATED TO SEE IF THE PATIENT FIRST QUALIFIES FOR ASSISTANCE FROM ANY FEDERAL, STATE, OR LOCAL COUNTY PROGRAMS SUCH AS MA. A REASONABLE PAYMENT SCHEDULE OVER A ONE OR TWO YEAR PERIOD WILL BE DETERMINED IN THE INTERVIEW PROCESS. THE PORTION THAT WILL BE WRITTEN OFF SHOULD THEN BE CLASSIFED AS A CHARITY DISCOUNT. INDIVIDUALS WITHIN TWO (2) TIMES THE FEDERAL POVERTY GUIDELINES MAY ALSO HAVE SOME MEDICAL INSURANCE COVERAGE. THE PATIENT DEDUCTABLE AND NONCOVERED SERVICES MAY BE LARGE ENOUGH THAT THE INDIVIDUAL IN INCAPABLE OF PAYING OFF WITHIN A 1-2 YEAR PERIOD. THEREFORE, THIS UNPAYABLE AMOUNT BY THE PATIENT MAY BE CLASSIFED AS CHARITY DISCOUNT. PART I, LINE 7: THE COSTS INCLUDED IN PART 1, LINES 7A AND 7B WERE DERIVED BY USING THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2 AND THEN APPLIED AGAINST INTERNALLY DEVELOPED NUMBERS. THE COSTS INCLUDED IN PART 1, LINES 7E, 7F AND 7I WERE ACTUAL COSTS TRACKED BY THE HEALTH SYSTEM IN THEIR FINANCIAL PROCESS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1525036. PART III, LINE 4: A COST-TO-CHARGE RATIO WAS USED TO REPORT BAD DEBT FIGURES. THE COST TO CHARGE RATIO WAS DERIVED FROM THE IRS INSTRUCTIONS FOR SCHEUDLE H, WORKSHEET 2. AMOUNTS ON LINE 3 WERE CALCULATED MANUALLY BY REVIEWING ALL BAD DEBT CHARGES FOR PATIENTS THAT HAD ANY MEDICAL ASSISTANCE OR PMAP/MNCARE COVERAGE AND GUARANTOR NOTES REGARDING CHARITY CARE. MOST OF THE VISITS INCLUDED IN THE TOTAL WERE FOR PATIENTS THAT MAY HAVE QUALIFIED FOR CHARITY CARE, BUT THEY CHOOSE NOT TO APPLY OR COMPLETE THE APPLICATION. MLHS DOES OFFER ASSISTANCE IN THE PREPARATION OF THE CHARITY CARE FORMS.FINANCIAL STATEMENT DISCLOSUREPATIENT AND RESIDENT SERVICE REVENUE IS RECORDED AT THE ORGANIZATION'S ESTABLISHED RATES WHEN THE SERVICE IS PROVIDED, WITH CONTRACTUAL ADJUSTMENTS DEDUCTED TO ARRIVE AT NET PATIENT AND RESIDENT SERVICE REVENUE. TOTAL CONTRACTUAL ADJUSTMENTS FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND 2010 WERE APPROXIMATELY $24,001,000 AND $20,405,000, RESPECTIVELY. THE ORGANIZATION PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES (CHARITY CARE) TO PATIENTS WHO MEET CERTAIN CRITERIA. CHARITY CARE AMOUNTS ARE NOT REPORTED AS REVENUE, AS THE ORGANIZATION DOES NOT PURSUE COLLECTION.PATIENT ACCOUNTS RECEIVABLE, WHERE A THIRD-PARTY PAYOR IS RESPONSIBLE FOR PAYING THE AMOUNT, ARE CARRIED AT A NET AMOUNT DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED, LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS.PATIENT ACCOUNTS RECEIVABLE DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS, AND BY CONSIDERING THE PATIENTS FINANCIAL HISTORY AND CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. TOTAL ALLOWANCE FOR DOUBTFUL ACCOUNTS AT SEPTEMBER 30, 2011 AND 2010 WERE APPROXIMATELY $2,124,000 AND $1,802,000, RESPECTIVELY. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED.THE ORGANIZATION HAS AGREEMENTS WITH THIRD-PARTY PAYORS WHICH PROVIDE FOR REIMBURSEMENT TO THE ORGANIZATION AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. THE PRIMARY PAYORS ARE MEDICARE, MEDICAID AND BLUE CROSS BLUE SHIELD.THE ORGANIZATION HAS A CONTRACT WITH MEDICARE AS A CRITICAL ACCESS HOSPITAL (CAH). UNDER CAH STATUS, HOSPITAL SERVICES PROVIDED TO MEDICARE BENEFICIARIES ARE PAID BASED UPON A COST-REIMBURSEMENT METHODOLOGY, WITH TENTATIVE RATES PAID DURING THE YEAR ON ALL INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF AN ANNUAL COST REPORT.BLUE CROSS BLUE SHIELD REIMBURSEMENT IS BASED ON THE ORGANIZATION'S ESTABLISHED RATES. MEDICAL ASSISTANCE REIMBURSEMENT FOR HOSPITAL PATIENTS IS BASED ON PROSPECTIVELY ESTABLISHED RATES. THE RATES CHARGED TO MEDICAL ASSISTANCE AND PRIVATE-PAY RESIDENTS AT THE NURSING HOME ARE ESTABLISHED IN ACCORDANCE WITH RULES OF THE STATE OF MINNESOTA.RETROACTIVELY CALCULATED CONTRACTUAL ADJUSTMENTS ARISING UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS ARE RECOGNIZED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.THE LAWS AND REGULATIONS UNDER WHICH THE MEDICARE AND MEDICAL ASSISTANCE PROGRAMS OPERATE ARE COMPLEX, SUBJECT TO FREQUENT CHANGE AND SUBJECT TO INTERPRETATION. AS PART OF OPERATING UNDER THESE PROGRAMS, THERE IS A POSSIBILITY THAT GOVERNMENTAL AUTHORITIES MAY REVIEW THE ORGANIZATION'S COMPLIANCE WITH THESE LAWS AND REGULATIONS. SUCH REVIEW MAY RESULT IN ADJUSTMENTS TO REIMBURSEMENT PREVIOUSLY RECEIVED AND SUBJECT THE ORGANIZATION TO FINES AND PENALTIES. ALTHOUGH NO ASSURANCES CAN BE GIVEN, MANAGEMENT BELIEVES THEY HAVE COMPLIED WITH THE REQUIREMENTS OF THE MEDICARE AND MEDICAL ASSISTANCE PROGRAMS. PART III, LINE 8: THE MEDICARE SHORT-FALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE: (1) IT PROVIDES SERVICES TO A SIGNIFICANT PORTION OF OUR SERVICE POPULATION AT A NEGATIVE MARGIN (2) THE HOSPITAL WOULD DISCONTINUE PROVIDING SERVICES TO MEDICARE PATIENTS IF THE DECISION WERE SOLEY FINANCIAL (3) THERE IS A COMMUNITY NEED TO PROVIDE THESE SERVICES AND (4) IF THE HOSPITAL DID NOT PROVIDE THESE SERVICES, THEY WOULD BECOME THE OBLIGATION OF THE GOVERNMENT. THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III WERE DERIVED FROM THE MEDICARE COST REPORT FILED BY THE HEALTH SYSTEM. PART VI, LINE 2: MILLE LACS HEALTH SYSTEM ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY THROUGH THE ORGANIZATION OF COMMUNITY MEETINGS - FEEDBACK FORUMS. THE ORGANIZERS PROVIDE CONSTANT FEEDBACK OF COMMUNITY NEEDS. THERE ARE COMMUNITY FOCUS GROUPS AND HOSPITAL STAFF ATTENDANCE AT VARIOUS CLUB MEETINGS TO PROVIDE HEALTH INFORMATION AND GUIDANCE ON HOW TO ACCESS TO THE HOSPITALS SERVICES. PART VI, LINE 3: ELIGIBILITY FOR ASSISTANCE INFORMATION IS ON THE BILLING STATEMENTS. THE HEALTH SYSTEM PROVIDES ARTICLE NEWSLETTERS AND COMMUNITY OUTREACH PROGRAMS ON SUCH PROGRAMS AVAILABLE TO THE PUBLIC. AN ASSISTANCE INFORMATION SHEET IS PROVIDED TO THE PATIENT OR REPRESENTATIVE AT THE TIME OF THE SERVICE OR AT A SCHEDULED MEETING FOR ELIGIBILITY. PART VI, LINE 4: MILLE LACS HEALTH SYSTEM IS LOCATED 80 MILES NORTH OF THE MINNEAPOLIS MN AREA IN CENTRAL MINNESOTA. THE HEALTH SYSTEM SERVES THE PREDOMINATELY RURAL AREA OF MILLE LACS COUNTY AND PORTIONS OF MORRISON, AITKIN, CROW WING AND KANABEC COUNTIES, PLUS THE MILLE LACS OJIBWE INDIAN RESERVATION. THE MILLE LACS PRIMARY SERVICE AREA INCLUDES 15,000 TO 18,000 YEAR ROUND RESIDENTS WITH THE POPULATION DOUBLING DURING THE PEAK TOURIST SEASON. PERSONS LIVING BELOW THE POVERTY LEVEL IS IN MILLE LACS COUNTY IS 13.4% FROM THE US CENSUS. THE DEMOGRAPHIC AN SOCIOECONOMIC PROFILE COMMON TO OUR RURAL COMMUNITY ALSO INFLUENCES THE DEMANDS ON OUR HEALTHCARE SYSTEM. RURAL AREAS IN GENERAL HAVE GREATER CONCENTRATIONS OF ELDERLY PEOPLE THAN DO URBAN AREAS. AN OLDER POPLULATION IS MORE LIKELY TO HAVE CHRONIC HEALTHCARE NEEDS, WHICH CAN PLACE A HEAVY BURDEN ON COMMUNITIES THAT ALREADY FACE PROVIDER SHORTAGES. PART VI, LINE 6: MILLE LACS HEALTH SYSTEM PROVIDES EDUCATIONAL HEALTH FAIRS,COMMUNITY MEETINGS ON HEALTH PROBLEMS, DIAGNOSIS AND PREVENTION METHODS. PART OF OUR MISSION STATEMENT IS TO ASSIST THOSE RESIDING IN AND VISITING THE MILLE LACS AREA IN ACHIEVING AND MAINTAINING OPTIMAL HEALTH. THE HEALTH SYSTEM PROVIDES PASTORAL CARE TO PATIENTS UPON REQUEST-FROM OUR AREA CHURCHES CLERGY. WE SEND OUT QUARTERLY COMMUNITY HEALTH INFORMATION NEWS LETTERS. WE PROVIDE FREE BLOOD PRESSURE TESTING PROGRAMS. REPORTS FILED WITH STATES PART VI, LINE 7 MN 1 MILLE LACS AREA HEALTH FOUNDATION INC 200 NORTH ELM STREET PO BOX A ONAMIA MN 56359 743155412 501(C)(3) 60000 GENERAL OPERATING SUPPORT. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE HEALTH SYSTEM'S ONLY GRANT WAS TO A RELATED FOUNDATION UNDER COMMON MANAGEMENT. X X X X 0 0 0 0 0 0 0 0 0 ARDEN VIRNIG 152524 0 101 0 24895 0 7075 0 555 0 185150 0 0 0 MAGGIE LARSON 144163 0 101 0 16002 0 6398 0 17694 0 184358 0 0 0 WILLIAM NELSON 184097 0 52481 0 11778 0 8459 0 6744 0 263559 0 0 0 TOM BRACKEN 163696 0 101 0 35034 0 6879 0 18591 0 224301 0 0 0 RODNEY HAYES 151315 0 101 0 17937 0 6707 0 17695 0 193755 0 0 0 KIM KUCERA 132890 0 101 0 8183 0 5621 0 16155 0 162950 0 0 0 SHARON GOSSETT 250016 0 101 0 262606 0 9800 0 15791 0 538314 0 0 0 CATHY DONOVAN 149659 0 101 0 19206 0 6114 0 13921 0 189001 0 0 0 PETER LINDBLOOM 147267 0 101 0 5847 0 6115 0 17808 0 177138 0 0 0 MARK MARSHALL 132506 0 101 0 4852 0 5438 0 7446 0 150343 0 0 0 ROGER BOETTCHER 152421 0 101 0 39219 0 7624 0 18592 0 217957 0 0 0 CITY OF ONAMIA 416005437 2003-06-24 4500000 NURSING HOME FACILITY 0 0 0 1097582 4500000 40431 4459569 2005 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 KEVIN ANDERSON KEVIN ANDERSON IS THE VICE CHAIRMAN OF THE BOARD OF DIRECTORS OF MLHS 139476 MILLE LACS MESSENGER, THE LOCAL NEWSPAPER, PROVIDES ADVERTISING FOR THE MILLE LACS HEALTH SYSTEM. THE MILLE LACS MESSENGER IS OWNED BY KEVIN ANDERSON. 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE PRESENTED AT A BOARD MEETING FOR APPROVAL BEFORE FILING THE TAX RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR/OFFICER OF MLHS SHALL COMPLETE AND SIGN A CONLFICT OF INTEREST QUESTIONNARIE UPON APPOINTMENT AND THEREAFTER AT THE TIME OF EACH ANNUAL MEETING. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CEO AND COMPLIANCE OFFICER. EACH DIRECTOR/OFFICER OF MLHS SHALL FULLY DISCLOSE ANY CONFLICTS OF INTERESTS. IF A CONFLICT OF INTEREST EXISTS, THE BOARD MEMBER/OFFICER MAY BE ASKED TO STEP DOWN. FORM 990, PART VI, SECTION B, LINE 15 CEO COMPENSATION IS EVALUATED BY THE BOARD OF DIRECTORS. COMPARABILITY DATA FROM OTHER AREA FACILITIES IS USED ALONG WITH AN EXECUTIVE SALARY SURVEY TO DETERMINE COMPENSATION FOR TOP MANAGEMENT OFFICIALS. FORM 990, PART VI, SECTION C, LINE 19 THE HEALTH SYSTEM'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. OVERLAP OF BOARD MEMBERS FORM 990, PART VII, SECTION A KEVIN ANDERSON AND MAGGIE LARSON ALSO SERVE ON THE BOARD OF DIRECTORS OF MILLE LACS HEALTH SYSTEM FOUNDATION. EACH BOARD MEMBER SPENDS APPROXIMATELY THE SAME AMOUNT OF TIME SERVING EACH OF THE RELATED ORGANIZATIONS, FOR A TOTAL OF 2 HOUR PER WEEK. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET ASSETS RELEASED FROM RESTRICTIONS -28,895. TOTAL TO FORM 990, PART XI, LINE 5: -28,895. MILLE LACS AREA HEALTH FOUNDATION INC 200 NORTH ELM STREET PO BOX A ONAMIA MN 56359 743155412 FUNDRAISING MN 501(C)(3) 7 N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0